Provider Demographics
NPI:1043381387
Name:MICHELLE D WILLIAMS LCSW CADC PC
Entity Type:Organization
Organization Name:MICHELLE D WILLIAMS LCSW CADC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:D
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, CADC
Authorized Official - Phone:773-722-8515
Mailing Address - Street 1:3410 W ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60624-4343
Mailing Address - Country:US
Mailing Address - Phone:773-722-8515
Mailing Address - Fax:773-722-8515
Practice Address - Street 1:3410 W ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60624-4343
Practice Address - Country:US
Practice Address - Phone:773-722-8515
Practice Address - Fax:773-722-8515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL212643Medicare ID - Type Unspecified